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1.
Ann Thorac Surg ; 109(2): e107-e108, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31276648

RESUMO

Patients undergoing sternotomy routinely undergo sternal closure with stainless steel wires. Occasionally these wires can fracture, although normally this presents no concern as the broken wire remains fixed and is not problematic. We report a case of a segment of a broken sternal wire that migrated through the pericardium onto the right ventricular. It was removed with a minimally invasive approach with endoscopic assistance.


Assuntos
Fios Ortopédicos/efeitos adversos , Remoção de Dispositivo/métodos , Endoscopia/métodos , Migração de Corpo Estranho/cirurgia , Traumatismos Cardíacos/cirurgia , Ventrículos do Coração/lesões , Pericárdio/lesões , Idoso , Falha de Equipamento , Feminino , Fluoroscopia , Migração de Corpo Estranho/diagnóstico , Traumatismos Cardíacos/diagnóstico , Traumatismos Cardíacos/etiologia , Ventrículos do Coração/diagnóstico por imagem , Humanos , Pericárdio/diagnóstico por imagem , Radiografia Torácica , Esternotomia/efeitos adversos
3.
Am J Forensic Med Pathol ; 41(1): 35-39, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31876539

RESUMO

The potential complications of cardiac surgery with sternotomy include mediastinitis and major bleeding, events that are infrequent but carry high mortality.We report a unique complication of median sternotomy. A 71-year-old man underwent coronary artery bypass grafting complicated by sternal dehiscence on postoperative day 7. One week after discharge, he presented with purulent drainage from the sternal wound bed and was diagnosed as having mediastinitis. Irrigation, debridement, and sternal reconstruction were performed. Two days later, bleeding was observed in the wound, and during surgical exploration, a tear in the right ventricle was discovered, and the patient exsanguinated and died. Autopsy findings included focal adhesions connecting the posterior sternum to the right ventricle wall, as well as microscopic evidence of focally extensive fatty infiltration along the rupture margin of the myocardium.Pertinent aspects of the case are reviewed, with particular attention to the possible microbial etiology of mediastinal infection and most likely mechanisms of injury contributing to the fatal right ventricular rupture.


Assuntos
Ponte de Artéria Coronária/efeitos adversos , Ventrículos do Coração/lesões , Mediastinite/etiologia , Esternotomia/efeitos adversos , Idoso , Exsanguinação/etiologia , Ventrículos do Coração/patologia , Humanos , Masculino , Ruptura Espontânea/patologia
4.
J Cardiothorac Surg ; 14(1): 185, 2019 Nov 04.
Artigo em Inglês | MEDLINE | ID: mdl-31684992

RESUMO

BACKGROUND: Cardiac radiofrequency ablation is a popular treatment for arrhythmias. However, it does have some complications, some of which are severe, even fatally. And there were limited reports on cardiac internal perforation after radiofrequency catheter ablation (RFCA) that required a surgical repair. CASE PRESENTATION: A 47-year-old male was admitted to our hospital due to chest congestion for 4 months. He received a radiofrequency catheter ablation (RFCA) 9 months prior to admission. On admission, an echocardiogram showed an abnormal perforation between the left ventricle and the left atrium with moderate mitral valve regurgitation. We therefore performed a mitral valve replacement (MVR) and fixed the abnormal atrial-ventricular breakage via median sternotomy. CONCLUSIONS: Cardiac perforation is a severe complication of cardiac RFCA, operators should be extremely cautious to minimize radiofrequency associated perforations. Such a challenging and complex procedure should be deliberately considered by doctors and patients before implementation.


Assuntos
Fibrilação Atrial/cirurgia , Ablação por Cateter/efeitos adversos , Traumatismos Cardíacos/diagnóstico , Ecocardiografia , Átrios do Coração/lesões , Traumatismos Cardíacos/diagnóstico por imagem , Traumatismos Cardíacos/cirurgia , Implante de Prótese de Valva Cardíaca , Ventrículos do Coração/lesões , Humanos , Masculino , Pessoa de Meia-Idade , Valva Mitral , Complicações Pós-Operatórias
5.
J Med Case Rep ; 13(1): 301, 2019 Sep 23.
Artigo em Inglês | MEDLINE | ID: mdl-31543075

RESUMO

BACKGROUND: Primary effusion lymphoma is a rare, high-grade non-Hodgkin's lymphoma that usually occurs in immunosuppressed or human immunodeficiency virus-positive individuals in advanced stages of the disease. However, primary effusion lymphoma occasionally affects immunocompetent patients who are infected with human herpes virus type 8 or Epstein-Barr virus. This disease manifests with liquid collections in cavities, producing constitutional symptoms; fever; weight loss; and symptoms related to extrinsic compression, such as dyspnea or abdominal discomfort. Diagnosis is confirmed with cytological or tissue evaluation showing large, multinucleated lymphoid cells with positive specific markers for the disease, such as CD45 and markers related to viral infections, when present. There is no standard treatment for primary effusion lymphoma, but several chemotherapy protocols are recommended, usually with poor results. CASE PRESENTATION: We present a case of an adult human immunodeficiency virus-negative Hispanic origin woman with primary effusion lymphoma with pleuritic, pericardial, and peritoneal compromise who also had unusual complications during a diagnostic procedure: the accidental rupture of the left ventricle and the development of a secondary left ventricular pseudoaneurysm. We describe the clinical, radiological, and laboratory characteristics as well as the outcome of this case. CONCLUSIONS: Primary effusion lymphoma is a very rare entity that represents 4% of non-Hodgkin's lymphoma cases associated with human immunodeficiency virus and 0.1% to 1% of all lymphomas in patients with another type of immunodeficiency in regions where human herpes virus type 8 is not endemic. This reported case is an unusual presentation of primary effusion lymphoma because it occurred in an immunocompetent human immunodeficiency virus-negative adult woman without the presence of Kaposi's sarcoma or Castleman's disease and for whom the clinical course after chemotherapy was successful. However, the rupture of the free wall of the left ventricle is a very rare catastrophic event that usually occurs after myocardial infarction. Left ventricle free wall rupture rarely goes unnoticed, but when it occurs, it leads to the development of a ventricular pseudoaneurysm in which the rupture is contained by the pericardium with an organized thrombus and an adjacent hematoma.


Assuntos
Traumatismos Cardíacos/etiologia , Ventrículos do Coração/lesões , Doença Iatrogênica , Linfoma de Efusão Primária/diagnóstico , Toracoscopia/efeitos adversos , Falso Aneurisma/diagnóstico por imagem , Falso Aneurisma/etiologia , Feminino , Humanos , Imunocompetência , Pessoa de Meia-Idade , Derrame Pericárdico/diagnóstico por imagem , Derrame Pleural/diagnóstico por imagem , Tomografia Computadorizada por Raios X
6.
Elife ; 82019 08 08.
Artigo em Inglês | MEDLINE | ID: mdl-31393264

RESUMO

Cardiac neural crest cells contribute to important portions of the cardiovascular system including the aorticopulmonary septum and cardiac ganglion. Using replication incompetent avian retroviruses for precise high-resolution lineage analysis, we uncover a previously undescribed neural crest contribution to cardiomyocytes of the ventricles in Gallus gallus, supported by Wnt1-Cre lineage analysis in Mus musculus. To test the intriguing possibility that neural crest cells contribute to heart repair, we examined Danio rerio adult heart regeneration in the neural crest transgenic line, Tg(-4.9sox10:eGFP). Whereas the adult heart has few sox10+ cells in the apex, sox10 and other neural crest regulatory network genes are upregulated in the regenerating myocardium after resection. The results suggest that neural crest cells contribute to many cardiovascular structures including cardiomyocytes across vertebrates and to the regenerating heart of teleost fish. Thus, understanding molecular mechanisms that control the normal development of the neural crest into cardiomyocytes and reactivation of the neural crest program upon regeneration may open potential therapeutic approaches to repair heart damage in amniotes.


Assuntos
Diferenciação Celular , Ventrículos do Coração/lesões , Miócitos Cardíacos/fisiologia , Crista Neural/fisiologia , Regeneração , Animais , Animais Geneticamente Modificados , Galinhas , Camundongos , Peixe-Zebra
7.
Ann Thorac Surg ; 108(6): e405-e407, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31470008

RESUMO

Chest tube thoracostomy is a standard procedure in every intensive care unit. Although it is regarded as a safe procedure in experienced hands, rare complications do occur. This report describes iatrogenic perforation of the left ventricle after placement of an intercostal catheter and the successful surgical management of this injury. Various operative situations that may arise in relation to iatrogenic perforation of the left ventricle are also discussed, as well as steps to manage this potentially life-threatening complication.


Assuntos
Tubos Torácicos/efeitos adversos , Ventrículos do Coração/lesões , Ventrículos do Coração/cirurgia , Abscesso Pulmonar/cirurgia , Toracostomia/métodos , Idoso , Seguimentos , Humanos , Doença Iatrogênica , Abscesso Pulmonar/diagnóstico , Masculino , Medição de Risco , Esternotomia/métodos , Resultado do Tratamento
8.
Braz J Cardiovasc Surg ; 34(4): 484-487, 2019 08 27.
Artigo em Inglês | MEDLINE | ID: mdl-31454204

RESUMO

Placement of a mediastinal drain is a routine procedure following heart surgery. Postoperative bed rest is often imposed due to the fear of potential risk of drain displacement and cardiac injury. We developed an encapsulating stitch as a feasible, effective and low-cost technique, which does not require advanced surgical skills for placement. This simple, novel approach compartmentalizes the drain allowing for safe early mobilization following cardiac surgery.


Assuntos
Ponte de Artéria Coronária , Drenagem/instrumentação , Monitorização Neurofisiológica Intraoperatória/métodos , Mediastino/cirurgia , Complicações Pós-Operatórias/prevenção & controle , Drenagem/métodos , Estudos de Viabilidade , Ventrículos do Coração/lesões , Humanos , Derrame Pericárdico/prevenção & controle
9.
Am J Case Rep ; 20: 1155-1158, 2019 Aug 07.
Artigo em Inglês | MEDLINE | ID: mdl-31387984

RESUMO

BACKGROUND Ventricular rupture is a complication of acute myocardial infarction (AMI) that results in hemopericardium and cardiac tamponade and has a high mortality rate. Most cases involve the left ventricular free wall, and there have been few previous reports of solitary right ventricular free wall rupture. This report is of a case of fatal right ventricular free wall rupture during percutaneous coronary intervention (PCI) for inferior acute myocardial infarction (AMI). CASE REPORT A 76-year-old woman underwent emergency coronary angiography following inferior AMI. During angiography and attempted percutaneous coronary intervention (PCI), sudden onset of cardiac arrest occurred due to cardiac tamponade. Blood was drained from the pericardium by pericardiocentesis. Despite of advanced cardiac support, the patient died. The post mortem findings showed a solitary right ventricular free wall rupture due to inferior myocardial infarction. CONCLUSIONS A rare case is presented of right ventricular free wall rupture following AMI that occurred during PCI. This case demonstrates that early diagnosis and management are required to prevent patient mortality.


Assuntos
Tamponamento Cardíaco/etiologia , Ruptura Cardíaca Pós-Infarto/etiologia , Ventrículos do Coração/lesões , Infarto Miocárdico de Parede Inferior/cirurgia , Intervenção Coronária Percutânea/efeitos adversos , Idoso , Evolução Fatal , Feminino , Humanos
10.
Interact Cardiovasc Thorac Surg ; 29(3): 365-370, 2019 09 01.
Artigo em Inglês | MEDLINE | ID: mdl-31135035

RESUMO

OBJECTIVES: The presence of a stiff guidewire in the apex of the left ventricle (LV) is a known risk factor for LV perforation. Our goal was to minimize the risk of LV rupture during transcatheter aortic valve implantation (TAVI) by omitting the interaction between the stiff guidewire and the LV apex using a modified procedure. METHODS: A TAVI protocol designed to allow minimal interaction between a stiff guidewire and the LV was developed in Linköping University Hospital in Sweden. A total of 316 patients were treated exclusively by this approach between March 2014 and May 2018. RESULTS: All procedures were completed successfully. There were no cases (0%) of ventricular perforation. Only 1 patient (0.3%) had a pericardial effusion, and it was due to annulus rupture. There was 1 case of acute kidney injury (0.3%). Five patients (1.6%) required a new permanent pacemaker. Stroke occurred in 3 patients (0.9%). No patient had valve embolization. Vascular complications were experienced by 6 patients (1.9%). A mild paravalvular leak occurred in 27 (8.5%) patients. At 30 days post-TAVI, 6 patients (2%) had died. The mortality rate at 1 year was 8.6% (n = 20/232). CONCLUSIONS: Our series shows that TAVI without the prolonged use of a stiff guidewire in the LV apex is feasible. The risk of LV perforation is eliminated by this approach, and other procedural complications are limited.


Assuntos
Estenose da Valva Aórtica/cirurgia , Traumatismos Cardíacos/prevenção & controle , Ventrículos do Coração/lesões , Substituição da Valva Aórtica Transcateter/efeitos adversos , Substituição da Valva Aórtica Transcateter/métodos , Idoso , Idoso de 80 Anos ou mais , Feminino , Traumatismos Cardíacos/etiologia , Humanos , Masculino , Marca-Passo Artificial , Estudos Retrospectivos , Fatores de Risco , Suécia , Resultado do Tratamento
12.
BMJ Case Rep ; 12(4)2019 Apr 08.
Artigo em Inglês | MEDLINE | ID: mdl-30967447

RESUMO

Left ventricular puncture during a thoracentesis is a rare and unusual complication that has yet to be reported. We report a case in which a 74-year-old woman with dilated ischaemic heart disease suffered from puncture of the left ventricle during a routine ultrasound-guided thoracentesis despite following the recommended protocol and procedures. She became haemodynamically unstable and underwent an emergent thoracotomy for removal of the catheter and repair of the left ventricular wall.


Assuntos
Cateterismo Cardíaco/efeitos adversos , Ventrículos do Coração/lesões , Hipertrofia Ventricular Esquerda/cirurgia , Toracentese/efeitos adversos , Idoso , Drenagem , Feminino , Humanos , Hipertrofia Ventricular Esquerda/diagnóstico por imagem , Complicações Pós-Operatórias , Punções , Ultrassonografia de Intervenção
13.
J Invasive Cardiol ; 31(5): E95, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31034443
16.
Forensic Sci Med Pathol ; 15(2): 272-275, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30649692

RESUMO

Cardiac injury following blunt chest trauma is common in motor vehicle accidents due to a crush or blast injury. Severe cardiac trauma is associated with a very high mortality. If a cardiac injury develops several weeks after non-penetrating chest trauma, establishing a causal link between the traumatic event and the cardiac injury becomes complicated. This article reports a case of fatal delayed hemopericardium and hemothorax following a motor vehicle accident including blunt chest trauma 34 days prior to death. The cardiac injury was caused by displacement of a sharp irregular fragment of one of the decedents fractured ribs and the primary defect was sealed by blood clots. Subsequent bleeding occurred when the thrombus was displaced. Since the incidence of blunt high-energy chest injuries is relatively high, heart and large vessel injuries must be taken into account and a comprehensive examination needs to be done in order to prevent the delayed development of fatal complications.


Assuntos
Hemotórax/etiologia , Derrame Pericárdico/etiologia , Traumatismos Torácicos/complicações , Ferimentos não Penetrantes/complicações , Acidentes de Trânsito , Feminino , Ventrículos do Coração/lesões , Ventrículos do Coração/patologia , Hemotórax/patologia , Humanos , Pessoa de Meia-Idade , Pedestres , Derrame Pericárdico/patologia , Fraturas das Costelas/complicações , Fraturas das Costelas/patologia , Choque Hemorrágico/etiologia , Trombose/patologia , Fatores de Tempo
17.
Ann Thorac Surg ; 107(6): e397-e398, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30414831

RESUMO

Perventricular ventricular septal defect closure has become an accepted method for treatment of some muscular and perimembranous ventricular septal defects. This report describes the case of a child who had left ventricular pseudoaneurysms after perventricular closure of a ventricular septal defect performed at 3 months of age. At 18 months, the ventricular pseudoaneurysms were closed surgically. Ventricular trauma from guidewire use during device placement was thought to be the cause. The potential for injury to the left ventricular free wall should be borne in mind and sought with serial imaging during and after perventricular septal defect closure.


Assuntos
Falso Aneurisma/etiologia , Comunicação Interventricular/cirurgia , Ventrículos do Coração/lesões , Complicações Pós-Operatórias/etiologia , Procedimentos Cirúrgicos Cardíacos , Humanos , Lactente , Masculino
18.
Am J Emerg Med ; 37(2): 377.e5-377.e6, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30413368

RESUMO

Thoracostomy tube placement is one of the more common procedures performed in the Emergency Department, most commonly for treatment of pneumothorax or hemothorax but occasionally for drainage of empyema or pleural effusion. Thoracostomy may be a life-saving procedure with a wide range of complication rates reported, ranging from 19.4-37%, most commonly extrathoracic placement. Most recent meta-analyses showed a relatively stable complication rate of 19% over the past three decades with the vast majority being benign in nature. We present a case with the rare complication of thoracostomy in which of a small-caliber thoracostomy tube was placed in the left ventricle. Although thoracotomy was performed to remove the catheter, the patient remained virtually asymptomatic and had an uneventful course.


Assuntos
Tubos Torácicos/efeitos adversos , Ventrículos do Coração/lesões , Toracostomia/efeitos adversos , Toracostomia/instrumentação , Adulto , Remoção de Dispositivo , Serviço Hospitalar de Emergência , Ventrículos do Coração/diagnóstico por imagem , Ventrículos do Coração/cirurgia , Humanos , Masculino , Pneumotórax/diagnóstico por imagem , Pneumotórax/etiologia , Pneumotórax/terapia , Radiografia , Toracotomia , Tomografia Computadorizada por Raios X , Ferimentos Perfurantes/complicações , Ferimentos Perfurantes/diagnóstico por imagem , Ferimentos Perfurantes/terapia
20.
Laryngoscope ; 129(6): 1420-1422, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-30408188

RESUMO

A 65-year-old female presented with a foreign body sensation following an asthmatic attack associated with severe coughing. Six years earlier, the patient underwent medialization laryngoplasty (ML), which was complicated by a small tear (2 mm) in the right ventricle. One year following this, the patient developed Gore-Tex extrusion but elected only for partial removal. Healing was complete until 5 years later; on examination, the patient had evidence of Gore-Tex extrusion through the right ventricle. Implant extrusion is a recognized complication of ML. This case demonstrates several important surgical steps that can benefit otolaryngologists at all stages of their surgical career. Laryngoscope, 129:1420-1422, 2019.


Assuntos
Ventrículos do Coração/lesões , Laringoplastia/efeitos adversos , Politetrafluoretileno/efeitos adversos , Falha de Prótese/efeitos adversos , Idoso , Feminino , Humanos
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